Delayed Right-Sided Hydrothorax after Right-Sided Subclavian Central Line Insertion

Complications associated with central venous catheters (CVC) can be early or delayed, and among them, hydrothorax is a rare one. Inappropriate initial positioning of the catheter, repeated changes in positioning and movement of the patient, and improper vigilance may be the causative factors. We describe a 47-year-old man with delayed right-sided hydrothorax after right-sided subclavian central line insertion. He was posted for anterior communicating artery aneurysmal clipping when the right-sided subclavian CVC was placed. His intraoperative and postoperative periods were uneventful. However, on postoperative day two, the patient developed labored breathing with desaturation to 76% of room air, with hypotension and tachycardia. An urgent chest x-ray was ordered and showed features suggestive of right-sided hydrothorax, which improved after right-sided intercostal drainage. This case report highlights the presentation of a rare complication of CVC and its recognition in patients with diminished consciousness. It also emphasizes the optimum site of positioning the CVC tip and the need for increased vigilance by healthcare providers in ordering routine chest x-rays, aspirating from all catheter ports prior to administering substances through them.